Epidemiology and clinical relevance 1 World thousands

Epidemiology and clinical relevance 1

World (thousands) cases: 204 Europe cases: 63 Deaths 125 Deaths 40 2

Age standardized mortality rates, UE _____ all ages ……… 35 -64 years La Vecchia et al, Ann Oncol 2010 3

Temporal trends of incidence and mortality rates, Italy AIRTUM, Epidemiologia e prevenzione 2006 4

Incidence and mortality rates in strata of age, Italy AIRTUM, Epidemiologia e prevenzione 2006 5

High incidence area High/low incidence areas incidence ratio Low incidence area Cervical cancer Columbia 15 Israel Breast cancer Canada, Columbia Britannica 7 Israel, Endometrial cancer USA, California 30 Japan Ovarian cancer Denmark 6 Japan not Jewish women 6

Serous 40 percent of all ovarian cancers; most common ovarian cancer Endometrioid 20 percent of all ovarian cancers; 15 percent of endometrioid carcinomas coexist with endometriosis; 40 percent bilateral Mucinous 25 percent of all ovarian cancers; origin unclear; may occur in association with endometriosis; associated with pseudomyxoma peritonei

Main factors associated with ovarian cancer risk Increased risk Decreased risk Early menarche/late menopause Early menopause/late menarche Endometriosis Multiparity Estrogen replacement therapy Hysterectomy Family history Oral contraceptive use Genetic syndromes High-fat diet Low parity Low-fat diet

Relative risk Attributable risk Nulliparity 2. 0 5 Menarche<11 y and menopause >50 y 1. 8 10 OC use. (>24 months) 0. 5 12 Familiarity 2. 1 2 Histerectomy 0. 7 3 9

HRT use and hystologic subtypes Serous Mucinous Risch et al. , 1996 1. 4 0. 7 Purdie et al. , 1999 Parazzini et al. , 2001 Endometriosis 1. 9 2. 6 1. 3 1. 4 1. 5 10

Published studies on the relation between fertility treatments and ovarian cancer risk Ron et al. , 1987 Shu et al. , 1989 Brinton et al. , 1989 Whittemore et al. , 1992 Harris et al. , 1992 Rossing et al. , 1994 Risch et al. , 1994 Franceschi et al. , 1994 Venn et al. , 1995 Purdie et al. , 1995 Shushan et al. , 1996 Parazzini et al. , 1997 Mosgaard et al. , 1997 Glud et al. , 1998 Modan et al. , 1998 Nugent et al. , 1998 Cramer et al. , 1998 Parazzini et al. , 1998 Potashnik et al. , 1999 Venn et al. , 1999 Klip et al. , 2000 Ness et al. , 2000 Parazzini et al. , 2001 Goodman et al. , 2001 Ness et al. , 2002 Lerner geva 2010 11

Fertility treatments od risk of ovarian cancer N. Total No yes 1016 Casi % N. Controlli % OR (95% CI) 98. 5% 15 2385 1. 5% 98. 9% 26 1. 0 1. 1% 1. 3 (0. 7 -2. 5) Nulliparae No 181 Yes 98. 4% 3 370 1. 6% 97. 1% 11 1. 0 2. 9% 0. 6 (0. 1 -2. 0) Parae No Yes 98. 6% 12 2015 1. 4% 99. 3% 15 1. 0 0. 7% 1. 9 (0. 9 -4. 1) 835 Parazzini et al. , 12 2001

Cases Controls Clomiphene No 1 -3 m 4 -12 > 12 Adj OR 892 17 16 9 1070 25 29 10 1. 0 0. 9 0. 8 1. 2 Gonadotropin No 916 1 -3 m 10 4 -12 6 > 12 1110 10 13 3 1. 0 1. 5 0. 6 1 95% C. I. (0. 5 - 1. 7) (0. 4 - 1. 4) (0. 5 - 3. 0) (0. 6 - 3. 6) (0. 2 - 1. 6) 4. 5 (0. 5 - 44. 1) Ness et al. , 2002 13

Incidence of ovarian cancer among patents with endometrioiss and the general Swedish population (Melin et al, 2006) 14

Diet and ovarian cancer • Cases-controls studies have shown a positive association between fat consumption and risk of ovarian cancer • Cases-controls studies have shown a negative association between fat vitamin A, C, E and risk of ovarian cancer • The women Health Initiative Dietary Modification Randomized Controlled Study has shown a decreased risk of ovarian cancer after 4 years of low fat diet(Prentice et al, 2007) 15

grazie 16